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General NPI Number Information
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NPI Number | 1326384058
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Entity Type | Individual
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Provider Name | JILL O'BRIEN MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 12/28/2012
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 1 LMU DR
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City | LOS ANGELES
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State | CA
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Zip | 90045-2650
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Country | US
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Telephone | 310-338-2340
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Fax | 310-338-5191
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Provider Business Mailing Address
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Address Line | 12239 W WASHINGTON BLVD APT B
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City | LOS ANGELES
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State | CA
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Zip | 90066-5518
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Country | US
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Telephone | 805-801-0170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 729
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License Number State | OK
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